Raynaud's phenomenon in an infant

A 5-month-old Caucasian female infant was admitted for evaluation of intermittent and evanescent "purpura" of 3 days' duration, when she developed areas of transient and recurrent blue to black discoloration of the skin of both calves.

Abstract

T i~ I s 5~-month-old Caucasian female infant was admitted for evaluation of intermittent and evanescent purpura of 3 days' duration. The patient's gestational, birth, and developmental histories were not remarkable. She was well until 3 days prior to admission, when she developed areas of transient and recurrent blue to black discoloration of the skin of both calves. Recurrences varied in location and were confined to the lower extremities until one day prior to admission, when blue-black discoloration of the fingers occurred. The patient also had mild fever and a poorly defined macular eruption of the upper trunk and neck. She was seen by her private pediatrician, hospitalized briefly elsewhere, and transferred to Children's Hospital. Physical examination showed an irritable, crying, normally developed, normally nourished female infant, who measured 25 inches in length and weighed 15 pounds, 7 ounces. The rectal temperature was 100.2 ~ F. Blood pressures in the arm and leg by the flush method were 80 mm. Hg and 100 ram. Hg, respectively. There was blotchy pallor of the trunk, profuse diaphoresis, and alternating cyanosis and blanching of both hands over a pe r iod of several minutes. Respirations were 64 per minute. The lungs were clear to auscultation; air exchange was good. The apical cardiac rate was 132 per minute. The heart was of normal size by percussion, and